Testing a new cognitive behavioural treatment for obesity: A randomized controlled trial with three-year follow-up

It is remarkably difficult for people with obesity to maintain a new lower weight following weight loss. The aim of the present study was to examine the immediate and longer-term effects of a new cognitive behavioural treatment that was explicitly designed to minimise this post-treatment weight regain. One hundred and fifty female participants with obesity were randomized to the new treatment, behaviour therapy (the leading alternative psychological treatment) or guided self-help (a minimal intervention). Both of the main treatments resulted in an average weight loss of about ten percent of initial weight whereas weight loss was more modest with guided self-help. The participants were subsequently followed-up for three years post-treatment. The great majority regained almost all the weight that they had lost with the new treatment being no better than the behavioural treatment in preventing weight regain. These findings lend further support to the notion that obesity is resistant to psychological methods of treatment, if anything other than a short-term perspective is taken. It is suggested that it is ethically questionable to claim that psychological treatments for obesity “work” in the absence of data on their longer-term effects.     

The relationship between short‐term memory and working memory: Complex span made simple?

This experiment addresses the question of what makes a working memory measure a good predictor of higher‐level abilities. Verbal and visuospatial processing episodes were interleaved with distinct verbal and visuospatial storage episodes to form four complex span tasks. Although these measures were reliable predictors of reading and mathematics ability in children, they were no more predictive of these abilities than corresponding simple span tasks involving storage alone. However, when individual differences in storage ability and processing capacity were controlled for, residual variance in complex span performance was related to academic ability in some cases. These findings indicate that complex span tasks are multiply determined, and that differences in task structure can dramatically influence the relative importance of these multiple constraints and the predictive power of a complex span measure.     

Immigration, suicidal ideation and deliberate self-injury in the Boston youth survey 2006

The prevalence and immigration-related correlates of deliberate self-injury (DSI) and suicidal ideation (SI) were estimated in a sample of Boston public high school students in 2006. Compared with U.S.-born youth, immigrant youth were not at increased risk for DSI or SI, even if they had experienced discrimination due to their ancestry. By contrast, U.S.-born youth who reported having been discriminated against because of their ancestry had an increased risk of deliberate self-injury (odds ratio [OR] = 3.1, 95% confidence interval [CI] = 1.6-5.9) and suicidal ideation (OR = 2.1, 95% CI = 1.2-3.8). The combination of being U.S.-born and experiencing ancestry-based discrimination identifies youth at increased risk for suicidal behavior.     

The import of the cortisol rise in child care differs as a function of behavioral inhibition

Children of ages 3 to 4.5 years (N = 107; 45 boys, 62 girls) were studied twice, 6 months apart, to examine whether the cortisol rise in child care at Time 1 (T1) was associated with (a) changes in anxious, vigilant behavior from T1 to Time 2 (T2) and (b) higher internalizing symptoms at T2. Controlling for measures of home environment and child care quality at T1, as well as for cortisol activity at T2, we obtained results indicating that behavioral inhibition moderated the associations between the rise in cortisol at T1 and child outcomes at T2 (i.e., anxious, vigilant behavior and internalizing symptoms). For both outcomes, the rise in cortisol at T1 became more positively predictive at increasing levels of behavioral inhibition. Specifically, at higher levels of behavioral inhibition, children with larger T1 cortisol increases expressed more internalizing symptoms than did children at lower levels of behavioral inhibition; in contrast, for those with low cortisol activity at T1, children with higher levels of inhibition expressed fewer internalizing symptoms than did children at lower levels of inhibition. In addition, children with higher levels of behavioral inhibition and lower cortisol activity at T1 exhibited reductions in anxious, vigilant behavior from T1 to T2, whereas at lower levels of behavioral inhibition, variations in the T1 cortisol rise bore no relation to changes in this behavior. These results suggest that the rise in cortisol at child care may have differential predictive value as a function of behaviorally inhibited temperament.     

Relations between Minnesota Multiphasic Personality Inventory-A scales and Rorschach variables with the scope and severity of maltreatment among adolescents

This study examined preexisting Rorschach (Exner, 2001) and Minnesota Multiphasic Personality Inventory-A (MMPI-A; Butcher et al., 1992) profiles to determine if selected MMPI-A scales and Rorschach variables would jointly associate with the number and severity of maltreatment subtypes (physical abuse, sexual abuse, neglect, and emotional maltreatment) of 157 adolescents (ages 14-17) with documented maltreatment histories. The Maltreatment Classification System was used to systematically code the maltreatment attributes. Six Rorschach variables (MOR, PER, Afr, SumY, SumC', Human Content) were significantly correlated with the number of maltreatment subtypes, but none of the anticipated MMPI-A scales were related. MMPI-A Scale 7 and Rorschach variables Ego, MOR, and PER were jointly associated with physical abuse severity. MMPI-A Scale 0 and Rorschach variables MOR, PER, SumY, SumC', PTI, Human Content, and Texture jointly associated with sexual abuse severity. This study supports the potential for certain MMPI-A scales and Rorschach variables to reflect the impact of adolescents' maltreatment experiences in terms of the number and severity of types of maltreatment experienced. Because both instruments captured different aspects of adolescents' maltreatment experiences, clinicians should consider using both when evaluating the impact of maltreatment on adolescents.     

Development and Evaluation of a Decision Aid for BRCA Carriers with Breast Cancer

BRCA+ breast cancer patients face high risk for a second breast cancer and ovarian cancer. Helping these women decide among risk-reducing options requires effectively conveying complex, emotionally-laden, information. To support their decision-making needs, we developed a web-based decision aid (DA) as an adjunct to genetic counseling. Phase 1 used focus groups to determine decision-making needs. These findings and the Ottawa Decision Support Framework guided the DA development. Phase 2 involved nine focus groups of four stakeholder types (BRCA+ breast cancer patients, breast cancer advocates, and genetics and oncology professionals) to evaluate the DA's decision-making utility, information content, visual display, and implementation. Overall, feedback was very favorable about the DA, especially a values and preferences ranking-exercise and an output page displaying personalized responses. Stakeholders were divided as to whether the DA should be offered at-home versus only in a clinical setting. This well-received DA will be further tested to determine accessibility and effectiveness.     

Anger and Irritability Symptoms among Youth with ODD: Cross-Informant Versus Source-Exclusive Syndromes

We examined differences in co-occurring psychological symptoms and background characteristics among clinically referred youth with oppositional defiant disorder (ODD) with and without anger/irritability symptoms (AIS) according to either parent or teacher (source-exclusive) and both informants (cross-informant), youth with noncompliant symptoms (NS) of ODD, and non-ODD clinic controls. Parents and teachers evaluated 1127 youth (ages 6-18) with a DSM-IV-referenced rating scale to assess ODD and co-occurring psychological symptoms. Parents also completed a background questionnaire (demographic, developmental, treatment, relationship, and academic characteristics) and teachers rated school functioning. Source-exclusive AIS groups were associated with different clinical features, and there was some evidence that cross-informant youth had more mental health concerns than source-exclusive groups. Findings varied to some extent among older (12-18?years) versus younger (6-11?years) youth. In general, the NS group (youth without AIS) was the most similar to clinic controls. AIS and NS are likely candidates for component phenotypes in ODD and continued research into their pathogenesis may have important implications for nosology, etiology, and intervention.     

Distinguishing highly confident accurate and inaccurate memory: insights about relevant and irrelevant influences on memory confidence

It is generally believed that accuracy and confidence in one's memory are related, but there are many instances when they diverge. Accordingly it is important to disentangle the factors that contribute to memory accuracy and confidence, especially those factors that contribute to confidence, but not accuracy. We used eye movements to separately measure fluent cue processing, the target recognition experience, and relative evidence assessment on recognition confidence and accuracy. Eye movements were monitored during a face-scene associative recognition task, in which participants first saw a scene cue, followed by a forced-choice recognition test for the associated face, with confidence ratings. Eye movement indices of the target recognition experience were largely indicative of accuracy, and showed a relationship to confidence for accurate decisions. In contrast, eye movements during the scene cue raised the possibility that more fluent cue processing was related to higher confidence for both accurate and inaccurate recognition decisions. In a second experiment we manipulated cue familiarity, and therefore cue fluency. Participants showed higher confidence for cue-target associations for when the cue was more familiar, especially for incorrect responses. These results suggest that over-reliance on cue familiarity and under-reliance on the target recognition experience may lead to erroneous confidence.     

A Reappraisal of the Nobody’s Perfect Program

Nobody’s Perfect Program (NP), involving 46 participants, was conducted from the spring of 2007 to the fall of 2009 in Peterborough, Canada. Prior to the program, parents completed demographic information, along with self-report measures assessing learned resourcefulness, the types of interactions with their children, parent resourcefulness, knowledge and use of resources, parent competency and self-efficacy, which were completed again after the program and at a 2 month follow-up testing. Most parents (83%) earned a certificate. Significant improvements over time were observed for parenting confidence satisfaction, knowledge about community resources, and parenting resourcefulness, with general learned resourcefulness skills approaching significance. Pre/post relative gains demonstrated in one attribute were associated with pre/post relative gains in others. Similarities and differences of these findings to a previous investigation are discussed, as well as the importance of parents’ general level of learned resourcefulness.     

Integrating Diabetes Self-Management Interventions for Mexican-Americans into the Catholic Church Setting

Churches provide an innovative and underutilized setting for diabetes self-management programs for Latinos. This study sought to formulate a conceptual framework for designing church-based programs that are tailored to the needs of the Latino community and that utilize church strengths and resources. To inform this model, we conducted six focus groups with mostly Mexican-American Catholic adults with diabetes and their family members (N = 37) and found that participants were interested in church-based diabetes programs that emphasized information sharing, skills building, and social networking. Our model demonstrates that many of these requested components can be integrated into the current structure and function of the church. However, additional mechanisms to facilitate access to medical care may be necessary to support community members’ diabetes care.